Healthcare Provider Details

I. General information

NPI: 1720204936
Provider Name (Legal Business Name): CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN ROAD SUITE 101
ANNANDALE VA
22003-6890
US

IV. Provider business mailing address

3301 WOODBURN ROAD SUITE 101
ANNANDALE VA
22003-6890
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-0800
  • Fax: 703-573-8809
Mailing address:
  • Phone: 703-573-0800
  • Fax: 703-573-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101052912
License Number StateVA

VIII. Authorized Official

Name: DR. ALBERT H. KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-573-0800